翼点锁孔入路鞍区手术间隙的显微解剖研究

Microsurgical anatomy of surgical spaces in sellar region via pterional keyhole approach

目的观察翼点锁孔入路中鞍区4个手术间隙的显微解剖特征，探讨这些间隙在鞍区显微外科手术中的应用。方法在6例（12侧）新鲜成人尸头标本上模拟翼点锁孔入路开颅，通过手术显微镜对鞍区手术常用的4个手术间隙及其内部结构进行解剖观察。结果间隙Ⅰ、Ⅱ、Ⅲ、Ⅳ及Willis环的全部得到了良好的暴露，对颈内动脉床突上端及其分支、基底动脉分叉部等鞍区重要结构进行描述。结论翼点锁孔入路可得到与标准翼点入路相同的有效显露范罔，熟悉鞍区解剖间隙的显微结构，保护穿通支是鞍区手术的关键。

Objective To study the anatomical feature of the four surgical spaces in sellar region via pterional keyhole approach, and explore the clinical application of these spaces to microsurgery. Methods The craniotomy through pterional keyhole approach to the seltar region was simulated on 6 （12 sides） adult cadaverie head specimens. Microsurgical anatomy of the 4 surgical spaces in the sellar region of all the specimens were observed under an operative microscope. Results The space Ⅰ -Ⅳ and Willis circle obtained by the microsurgery via this approach in the sellar region were excellent exposure, and the important structures of the sellar region such as the supraclinoid portion of the internal carotid artery and its branches and the furcation of the basilar artery were described. Conclusion The operative field necessary for observation of intracranial structures was also as good as that by the microsurgery via the classic pterional approach. Understanding the microsurgical anatomy of the operating spaces in the sellar region and protection of perforating branches are the key to the successful operation in the sellar region.